Instalment prescriptions

The treatment of addiction to certain drugs utilises substitution therapy. This is where the drug that the patient is addicted to is substituted for another drug that may be prescribed on a prescription form. Drugs allowed as substitutes are (most commonly) methadone, buprenor-phine, dextromoramide, morphine and pethidine. In addition, it is possible for prescribers to prescribe diazepam on instalment prescriptions for the management of side-effects to addiction treatment. 

Any pattern of instalments on an instalment prescription is permitted, although (for England and Wales) prescribers should limit their supply to 14 days (30 days for Scotland). For details of the different drugs which may be prescribed in... 

Instalment prescriptions covering more than one day should be collected on the specified day if this collection is missed the remainder of the instalment (i.e. the instalment less the amount prescribed for the day(s) missed) may be supplied. 

Therefore if, for example, a patient collected his instalments on Monday (for Monday and Tuesday), Wednesday (for Wednesday and Thursday) and Friday (for Friday, Saturday and Sunday), but failed to collect the instalments on a Friday, he would have to either wait until Monday to collect the next set of instalments, or visit the prescriber (on Saturday or Sunday) to gain a prescription to cover the intervening days. However, if the instalment prescription contained the wording as detailed above and if the patient failed to collect his instalments on Friday but came to the pharmacy on Saturday, he would still be able to collect Saturday s and Sunday s instalments (although not Friday s). 

The focus of codes and standards will shift from specifying the installation of prescriptive measures to the actual performance of the final building. This shift... 

Design-based, or prescriptive, standards, however, specify the materials and design for components, subsystems, and systems that are covered by the standard. An example of such standards are those found in the ASME s Boiler and Pressure Vessel Code, which specify the materials, design, fabrication, installation, testing and inspection, and operation and maintenance that boilers and pressure vessels must meet. Such prescriptive standards are common for stationary components and systems that must be approved by state and local code officials. Most of these requirements are based on historical practice and safety experience and have served the affected industries well. 

In addition, it is important not to confuse repeatable non-NHS (private) prescriptions with instalment dispensing for addicts (see Section 6.3.5), where the NHS prescription is only dispensed once although the dispensing takes place in instalments. 

The validity of prescriptions for controlled drugs has been reduced from 13 weeks to 28 days. The 28 days is from the date the prescription was signed or from the specified start date (see instalment dispensing for addicts (Section 6.3.5)) and applies to Schedule 2, Schedule 3 and Schedule 4 controlled drugs. 

Repeats of Schedule 2 and Schedule 3 drugs are not allowed, but instalments are (this is particularly useful with addicts prescriptions see Section 6.3.5). 

Until recently there was a strict rule that instalments could only be collected on the day specified. However, if the prescriber includes the following wording (or similar wording approved by the Home Office) on the prescription then exceptions can be made ... 

Figure 6.4 An example of a prescription form used for the instalment supply of substitution therapy to patients suffering from drug addiction in England (FP10MDA).

As if problems such as these were not enough to call into question the wisdom of the detailed prescriptive approach which had been requested by the Sea Gem Inquiry and enthusiastically endorsed by Parliament, there is in fact one more issue that appears to hammer a final nail into the coffin. Recognising that health and safety at work was a general problem in all industries, a government-sponsored inquiry had been established under the chairmanship of Lord Robens to consider the matter in its entirety. Reporting in 1972, after the passing of the Mineral Workings (Offshore Installations) Act but before it had entered into force, the... 

The HMRI had responsibility for the approval of new railway infrastructure and had developed over many years detailed standards for the design, installation and maintenance of railway equipment and hardware. These were incorporated in a document known to all as the Blue Book which acted as Bible for railway designers both within BR and LUL and the railway supply industry. However, over time the document had become outdated and a revision was planned in the late 1980s to take on board technical standards changes but still in the traditional prescriptive format. 

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